Healthcare Provider Details

I. General information

NPI: 1467937243
Provider Name (Legal Business Name): VITAL WELLNESS HOME HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2681 MONTEGA DR. SUITE E
SPRINGFIELD IL
60704
US

IV. Provider business mailing address

1717 HOWARD ST
EVANSTON IL
60202-3735
US

V. Phone/Fax

Practice location:
  • Phone: 217-717-1909
  • Fax: 217-717-1957
Mailing address:
  • Phone: 177-333-9568
  • Fax: 773-345-4637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NELIA LAUREL- LADLAD
Title or Position: CEO
Credential:
Phone: 773-332-9568